Individual
THOMAS JOSEPH STACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
421 FALLSWAY, BALTIMORE, MD 21202-4800
(410) 837-5533
(410) 837-8020
Mailing address
421 FALLSWAY, BALTIMORE, MD 21202-4800
(410) 837-5533
(410) 837-8020
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
14396
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
383841200
—
MD
Enumeration date
05/18/2009
Last updated
10/12/2015
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